Application form

Patient
Have you previously been a patient at Sahlgrenska University Hospital/Sahlgrenska International Care AB?
Gender

Enter in a format of YYYYMMDD. ex: 19881208

Contact Person
Contact information to physician in the home country or country where the patient has been treated
Medical Care
I'm interested in
How will the medical care be financed?
How did you get in contact with Sahlgrenska International Care?
GDPR
The collection and processing of personal data is regulated in the General Data Protection Regulation (GDPR)

Sahlgrenska International Care AB needs your consent to store personal information about you. The information will be used by employees at Sahlgrenska International Care AB and by the caregivers within Region Västra Götaland involved in processing your request for planned medical care.

The information that we intend to collect is name, date of birth, address and data concerning your medical condition and planned treatments. It will be stored in our file system.

Personal information required to make hotel reservations or other services related to your medical care may be disclosed to external recipients. If necessary for continued care or invoicing purposes personal data will be transferred to concerned authorities and/or caregivers abroad.

You can contact info@sahlgrenskaic.com to receive more information about what data we store about you or to ask for data to be erased, transferred, limited or corrected.

Fields marked with an asterisk ( * ) are mandatory.

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